title: Management of leak from the tip of the "J" in ileal pouch-anal anastomosis.
abstract: BACKGROUND
  Diagnosis and management of leak from the tip of the J-pouch after IPAA has not been systematically studied.
  
  
  OBJECTIVE
  The aim of this study is to report our experience in the diagnosis and management of these leaks following primary IPAA.
  
  
  METHODS
  This study is a retrospective review of prospectively gathered data.
  
  
  METHODS
  Data were obtained from a prospectively maintained single-institution pelvic pouch database.
  
  
  METHODS
  Included in this study were patients with a leak from the tip of the J-pouch after primary IPAA.
  
  
  METHODS
  The main measures of outcomes after salvage surgery were pouch failure, pouch function, and quality of life.
  
  
  RESULTS
  There were 27 (14 male) patients. Median age was 37 years (range, 20-73). Underlying disease in these patients was ulcerative colitis in 22 patients. Predominant symptoms were abdominal pain (n = 15) and fever (n = 5). Twenty patients had either a pelvic abscess detected by CT or MRI or a leak demonstrated at gastrografin enema or pouchoscopy. In 6 patients, the diagnosis was only made at salvage surgery. In 1 patient, the leak-associated abscess was detected during emergent laparotomy for acute peritonitis before salvage surgery. Of 27 patients, 1 had successful CT-guided drainage without the need for further surgery. Another patient had pouch resection with end ileostomy. Salvage surgery was performed in 25 patients by means of pouch repair (n = 23) and new pouch creation (n = 2); 8 patients had a repeat anastomosis. Median time from primary IPAA to salvage surgery was 0.9 years (0.13-9.8). Twenty-four patients with salvage surgery have a functioning pouch after a mean follow-up of 3.2 ± 1.9 years.
  
  
  CONCLUSIONS
  : The study was limited by its retrospective nature.
  
  
  CONCLUSIONS
  Leak from the tip of the J-pouch is indolent and diagnosis can be difficult. Satisfactory outcomes in terms of pouch retention may be expected after appropriate surgical management.
authors.affiliation: Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA. kiranp@ccf.org
authors.forename: Hasan T
authors.initials: HT
authors.lastname: Kirat
authors.forename: Ravi P
authors.initials: RP
authors.lastname: Kiran
authors.forename: Mustafa
authors.initials: M
authors.lastname: Oncel
authors.forename: Bo
authors.initials: B
authors.lastname: Shen
authors.forename: Victor W
authors.initials: VW
authors.lastname: Fazio
authors.forename: Feza H
authors.initials: FH
authors.lastname: Remzi
mesh_terms: D000328:Adult; D000368:Aged; D057868:Anastomotic Leak / Q000175:diagnosis / Q000628:therapy*; D016009:Chi-Square Distribution; D039021:Colonic Pouches; D004322:Drainage; D004733:Enema; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D016737:Proctocolectomy, Restorative; D011788:Quality of Life; D012189:Retrospective Studies; D016879:Salvage Therapy; D018709:Statistics, Nonparametric; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome